S476 PPI Discontinuation Rates in Patients With Esophageal Strictures
Bibliographic record
Abstract
Introduction: In March 2018, Canadian physicians received notification of new guidelines encouraging PPI deprescription in most patients with GERD.1 An adverse event from PPI discontinuation is rebound acid reflux leading to esophageal stricture. This study aims to quantify the proportion of patients with esophageal strictures requiring endoscopic dilation who had previously discontinued their PPI medication before and after implementation of these new guidelines. Methods: This retrospective cohort study analyzed patients who received an esophageal dilation between the years of 2015-2017 (group 1) and 2019-2021 (group 2). The outcome of interest was the rate of PPI discontinuation between the two groups. All patients from two gastroenterology practices who received esophageal dilations to treat symptomatic strictures during these years were identified for the study using physician billing codes. Information regarding demographics, medications, and previous GI diagnoses were collected using endoscopy reports and medication records from the local hospital medical database. We defined PPI discontinuation as either a 50% dose reduction, frequency reduction or complete medication discontinuation at the time of endoscopic dilation compared to the established PPI therapy from the previous 3 months or longer. The information was coded using a standardized data sheet and entered into SPSS for data analysis. Results: Data were collected from 223 esophageal dilations. The average patient age of the sample was 58.8 years old. The sample consisted of 124 males (56%) and 99 females (44%). Patients receiving dilations from group 1 (2015-17) had a PPI discontinuation rate of 6.5% (10/152 cases). Meanwhile, patients from group 2 (2019-21) had a PPI discontinuation rate of 24% (17/71 cases). These results were statistically significant (p<0.001) following Chi-Squared analysis (Table). Conclusion: There was a higher rate of PPI discontinuation in patients undergoing esophageal dilation after new PPI deprescription guidelines were sent to physicians. PPI deprescription recommendations may have unintended consequences. Further research is necessary to understand the risks and benefits of discontinuing PPI therapy. 1- https://tinyurl.com/2p8t9a7b Table 1. - Fisher Exact test: p value <0.001 Chi-Squared PPI Discontinued PPI Non-discontinued Total Group 1 10 142 152 Group 2 17 54 71 Total 27 196 223
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".